||I’m feeling refreshed after a nice, relaxing weekend. Today, I’m rotating at Impact Mental Health – a free clinic for uninsured patients. It’s been a great experience thus far. This is a rewarding patient population to work with, and they are often extremely grateful for the care we provide. This rotation is useful for learning the ins and outs of treating patients with limited financial resources – such as working with medication samples and donated medications, affordable options for therapy, etc. Given the transition to telehealth in the setting of COVID-19, I get to spend the day with my Yorkie, Milo, snuggling on my lap while I see patients from my home office. I have a new patient evaluation and a few follow-ups today. I appreciate the extra time I get to spend with patients at this clinic, as new patient evaluations are scheduled for 90 minutes and follow-ups are 30 minutes. I have supervision via Zoom with two of the fourth year residents and our attending. We learn about some of the newer medications on the market that we often don’t get to prescribe because they are cost-prohibitive for many patients. However, this clinic has access to free samples of medications such as Vraylar, Trintellix, etc. If indicated, we can start patients with some free samples and then help them apply for patient assistance programs. Because of this, we will likely be able to get my patient a year’s worth of medication at no cost. Additionally, one of the fourth year residents reaches out to me after supervision to share some additional tips/tricks. I’m so thankful to have such smart, kind co-residents. After finishing up with my last patient, my husband and I meet up with a co-resident that lives nearby for a socially-distanced dog walk. The pups love getting outside!
||Today, I am at UNI Downtown for Resident Continuity Clinic. Tuesdays are typically my busier days though I enjoy working with patients that can be more a bit more complicated. We have great attendings for supervision who are very knowledgeable and always available should any questions arise. I am mostly seeing transition-of-care patients at the moment (patients of the prior year’s fourth year residents that are now being reassigned to incoming third years). During morning supervision, we review antidepressant cross-tapers as well as the psychopharmacology of barbiturates. I head outside to eat my lunch and go for a stroll around the downtown area. I’m always cold, and the hot sun feels good! I see a couple more follow-ups. During afternoon supervision, we again have the opportunity to discuss any challenging or interesting cases. My attending then wraps things up by discussing typical target doses of various SSRIs and when we should think about switching to a different agent. After wrapping up my notes, I head home. My husband had a long day in his work as a surgical PA for the transplant service at the U of U, so I make dinner (I’m spoiled in that he typically does the grocery shopping and prepares our meals given his prior career as a dietitian). We down our yakisoba noodles while catching up on our shows. I stay up a bit later and spend the rest of the evening reading up on treatment-resistant depression and MAOIs.
||I have a dental appointment this morning – it always feels good to get my teeth cleaned! I often schedule doctor’s appointments, etc. for Wednesdays as I usually have some free time before or after lectures, which is so convenient. One of the major distinctions about our program compared to others is we have a full day, every Wednesday, dedicated to didactics. We have no clinical duties on these days, and it’s nice to catch up with my co-residents and attend some great lectures. Things are a little different than usual, as everything is being conducted via Zoom due to the COVID-19 pandemic. But I still enjoy seeing everyone’s smiling faces and their adorable pets! Milo makes an appearance to greet the new interns at our resident meeting (per one of our chief resident’s request – he also has a tiny Yorkie at home, and we may or may not have dressed them in matching Hawaiian shirts at one point). My husband has today off, so we have lunch together when the morning’s lectures are finished. In the afternoon, we learn about assessing suicidality in adolescent populations from Dr. Gray, a knowledgeable and compassionate suicidologist and child psychiatrist that has worked for UNI for many years. We finish up around 4PM. We decide to stretch our legs and take Milo for a walk at a small park near our home. I review my patients for tomorrow and prep some notes. My husband makes some delicious mushroom ravioli with sage brown butter sauce – yum! After catching up on a few shows, I wrap up the night by reading a couple papers my attending sent me about the neuroanatomy of addiction.
||It’s a bit of a slower day at the VA SOAR Clinic – a clinic largely focused on opioid use disorder. We don’t get started until 10AM, so it’s nice to sleep in. My attending and I spend some time chatting about our patients and catching up. He’s a great resource – I’ve already learned lots about drug screening, and I’ve only been at this clinic for two weeks! We wrap things up for the morning, and I then head to West Ridge Clinic for my Mental Health Integration rotation. It’s a bit of a drive (about 25 minutes), but it’s nice to have some time to myself. My role is to be present in the clinic to serve as an in-person resource for providers as well as see patients that are referred by their PCP. This rotation is a great way to deliver psychiatric services to patients that otherwise may have to wait several months to see a psychiatrist or who don’t necessarily need to see a psychiatric provider on a regular basis. I end up having a mutual patient from my continuity clinic with one of the PCPs. In between consultations, we catch up about our patient and are able to brainstorm ways to further work-up any medical etiology that may be contributing to treatment-resistant depression. I see a new patient and staff with my attending via phone – we review the psychiatric manifestations of PCOS and the concept of survivor’s guilt. Supervision as a third year feels very well-rounded, as I not only feel supported from a pharmacologic but also a psychotherapeutic standpoint. This particular patient’s PCP is working in clinic today, so I am able to touch base with her in-person to review my findings and recommendations. The providers here are great to work with, and she’s grateful for my assistance. I finish up my notes and take off for the day. Neither my husband and I feel like cooking, so we decide to pick up some take-out. One of our favorite restaurants in the area is Jinya. We eat some tasty ramen (despite it being nearly 100 degrees outside – it’s that good!) and then FaceTime with my nieces and nephew in Boise. I miss them so much and love seeing their darling faces. They show me some of their newest dance moves, which makes me laugh and brings a big smile to my face. I chart review a few more patients for tomorrow and then head to bed.
||After a quick protein shake, I get started on telehealth visits for the UNI Recovery Clinic. My supervisor is great – very knowledgeable, kind, and patient. We have supervision earlier today, and she provides me with several great resources to brush up on medication assisted treatment for my patients. We end a bit early today, so I spend the rest of the morning catching up on some reading and emails. After a quick lunch, I head to the UNI Home Clinic which is conveniently located only five minutes from my house. I have been looking forward to this rotation since my intern year. UNI Home is an integrative care clinic that serves patients with developmental disabilities across the life span. I am so thankful for the opportunity to learn how to best serve this patient population. Today, we see a patient with CHARGE syndrome, and my attending blows me away with his sign language skills. After we’ve seen the rest of our patients for the day, we discuss distinguishing OCD symptoms in patients with autism, as well as psychopharmacology and dosing strategies in neuroatypical patients. Our day wraps up around 4PM, and I head back home. After having some quick leftovers, my husband and I drive about 30 minutes to Jordanelle State Park to go boating with my friend from medical school who matched to the U for pediatrics; it’s so nice to be reunited! She and her husband just purchased a boat and have been enjoying this hot summer weather. We spend the rest of the evening relaxing on the water and wake-boarding – what a great start to the weekend!
|SATURDAY / SUNDAY
||We were planning on going kayaking this weekend – rentals through the U are affordable and convenient. However, we decide to sleep in instead since we’re feeling a bit tired from boating. After doing some quick grocery shopping and researching summer water toys for my nieces and nephew (7-foot inflatable unicorn that sprays water from its horn? – sold), we decide to go on a bike ride at Sugar House Park. It’s hot but feels so good to cruise downhill. Of course, Milo joins. We have a front facing harness for him (ridiculous, right?) and get lots of double-takes as my husband cruises by with a three-pound Yorkie strapped to his chest. For a post-ride treat, we head to our favorite ice cream shop – Normal Ice Cream. They have awesome and unique flavors like fruity pebbles and popcorn. We decide on salted caramel and green apple, which did not disappoint. We spend the rest of the weekend relaxing, and I wrap things up on Sunday by reviewing charts and prepping notes for the week – another successful weekend!